Journal of the American Podiatric Medical Association
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J Am Podiatr Med Assoc · May 2009
ReviewDefinitions of hammer toe and claw toe: an evaluation of the literature.
Lesser toe surgery is among the most conducted interventions in general orthopedic practice. However, the definitions of hammer toe and claw toe are not uniform. The objective of this literature study is to propose clear definitions for these deformities to establish unambiguous communication. ⋯ There are variations in the definitions of lesser toe deformities in the literature. We propose that extension of the metatarsophalangeal joint is the discriminating factor and essential characteristic for claw toe. Claw toe and hammer toe should be characterized by flexion in the proximal interphalangeal joint, which is the single criterion for a hammer toe. The flexibility of these joints could be a basic factor in discriminating between these deformities. The development of these deformities should be regarded as a continuum in the same pathophysiologic process.
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J Am Podiatr Med Assoc · May 2009
ReviewEvidence-based podiatric medicine: importance of systematic reviews in clinical practice.
Due to the exponential increase in the quantity and quality of podiatric medicine-related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and synthesize the best evidence from all clinical trials to answer clearly defined clinical questions. ⋯ Although more than 60 countries worldwide have open online access to The Cochrane Library, in the United States, only the state of Wyoming has free access to full-text reviews. In an era demanding an evidence-based approach for every clinical intervention, high-quality systematic reviews streamline podiatric medical literature by reducing the time, cost, and training necessary to establish a solid evidence base for practice.
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J Am Podiatr Med Assoc · Jan 2009
Effect of coexisting foot deformity on disability in women with knee osteoarthritis.
Knee osteoarthritis, a common musculoskeletal disorder, can cause considerable pain and disability. This study investigates the effect of certain foot deformities on the functional status of women with knee osteoarthritis. ⋯ There is a significant correlation between indicators of pain and disability (visual analog scale and WOMAC scores). Also, the presence of foot deformities increased disability levels in women with knee osteoarthritis.
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J Am Podiatr Med Assoc · Nov 2007
Case ReportsFracture of the lateral cuneiform only: a rare foot injury.
The three (medial, intermediate, and lateral) cuneiforms and their articulations in the foot are small and relatively well protected from injury. An isolated fracture of the lateral cuneiform is a rare finding. However, isolated injuries may occur as the result of direct trauma. ⋯ As each of the cuneiform bones articulates with four other bones in the midpart of the foot, persistent displacement of any fracture (subluxation or dislocation) may result in post-traumatic arthritis. We believe that in suspected cases with negative radiographic findings, further imaging (computed tomography or bone scanning) should be requested. Without the use of additional imaging techniques, many fractures may be misdiagnosed as ankle sprains or foot contusions, and patients may be discharged from the hospital.
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There is a well-known phenomenon of publication bias toward manuscripts that report statistically significant differences. The clinical implications of these statistically significant differences are not always clear because the magnitude of the changes may be clinically meaningless. This article relates the critical P value threshold to the magnitude of the actual observed change and provides a rationale for reporting confidence intervals in clinical studies. Strategies for improving statistical power and reducing the magnitude of the confidence interval range for clinical trials are also described.